替格瑞洛对急性心肌梗死患者行急诊介入治疗的疗效观察

Observation on efficacy of ticagrelor on patients with acute myocardial infarction treated by emergency interventional therapy

目的探讨替格瑞洛对急性心肌梗死(AMI)患者急诊行经皮冠状动脉介入治疗(PCI)的效果及安全性。方法 80例发病时间<24 h急诊行经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者,随机分为对照组和试验组,各40例。对照组采用阿司匹林联合氯吡格雷治疗,试验组采用阿司匹林联合替格瑞洛治疗,比较两组患者治疗前后心肌梗死溶栓治疗(TIMI)血流分级情况及治疗后1 h内心电图ST段回落情况、术后1周内左室舒张末期内径(LVED)、左心室射血分数(LVEF)。结果治疗前两组血流分级情况比较差异无统计学意义(P>0.05);治疗后试验组0～1级占比为5.0%, 2～3级占比为95.0%,均优于对照组的25.0%、75.0%,差异具有统计学意义(P<0.05)。试验组治疗后1 h内ST段回落>50%患者占比为87.5%(35/40)多于对照组的65.0%(26/40);LVEF(56.15±5.85)%、术后1周内LVED(49.83±4.43)mm均优于对照组的(52.62±5.85)%、(52.70±4.23)mm,差异具有统计学意义(P<0.05)。结论替格瑞洛可有效改善急诊行经皮冠状动脉介入治疗的急性心肌梗死患者的冠状动脉灌注血流和心功能,且安全性较高,临床治疗效果好,具有较高临床推广应用价值。

Objective To discuss the effect and safety of ticagrelor on patients with acute myocardial infarction(AMI) treated by emergency percutaneous coronary intervention(PCI). Methods A total of 80 patients with acute ST-segment elevation myocardial infarction treated with percutaneous coronary intervention with onset time <24 h were randomly divided into control group and experimental group, with 40 cases in each group. The control group was treated with aspirin and clopidogrel, and the experimental group was treated with aspirin and ticagrelor. Comparison were made on thrombolysis in myocardial infarction(TIMI) blood flow classification before and after treatment, electrocardiogram ST-segment fall within 1 h of treatment, left ventricular end-diastolic diameter(LVED) and left ventricular ejection fraction(LVEF) within 1 week after operation between the two groups. Results Before treatment, there was no statistically significant difference in blood flow classification between the two groups(P>0.05). After treatment, the experimental group had proportion of 0~1 grade as 5.0%, and 2~3 grade as 95.0%, which were better than 25.0% and 75.0% in the control group. Their difference was statistically significant(P<0.05). After treatment, the experimental group had higher proportion of ST-segment fall >50% within 1 h as 87.5%(35/40) than 65.0%(26/40) in the control group, and better LVEF as(56.15±5.85)% and LVED in 1 week after operation as(49.83±4.43) mm than(52.62±5.85)% and(52.70±4.23) mm in the control group. Their difference was statistically significant(P<0.05). Conclusion Ticagrelor can effectively improve coronary perfusion blood flow and cardiac function in patients with acute myocardial infarction undergoing emergency percutaneous coronary intervention with high safety and good clinical effect. This method has high clinical promotion and application value.